MH and SUD Medical and Related Services/Coding

 

 

Behavioral Health Medications

MH Conditions

CPT/HCPCS         Modifier  Description

 

Behavioral Health Medications

SUD Conditions

CPT/HCPCS Modifier Description

 

J0400                                    Injection, aripiprazole (Abilify), intramuscular, 0.25 mg

 

J0401                                    Injection, aripiprazole (Abilify), 1 mg

J0515                                    Cogentin (benztropine mesylate, per 1mg

J1200                                    Diphenhydramine hcl (Benadryl), up to 50 mg

Buprenorphine/naloxone administration, Administration of oral, intramuscular and/or T1502 subcutaneous medication by health care agency/professional, per visit

Alcohol and/or drug services; methadone administration and/or service (provision of H0020       the drug by a licensed program)

J0571                              Buprenorphine, oral, 1 mg

J0572                              Buprenorphine/naloxone, oral, less than or equal to 3 mg

J1630                                    Haloperidol Injection, Up to 5 mg

J0573                              Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg

J1631                                    Haloperidol Decanoate Injection per 50 mg

J2212                                    Injection, methylnaltrexone (Relistor), 0.1 mg

J2060                                    Lorazepam Injection, 2mg

J2358                                    Olanzapine Long Acting Injectable 1 mg

J2426                                    Paliperidone Palmitate Injection (Invega Sustenna or Invega Trinza), 1 mg

J2680                                    Fluphenazine Decanoate Injection 25 mg

J2794                                    Risperidone, Long Acting, .5 mg

J3360                                    Valium Injection, Up to 5 mg

J0574                              Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg J0575    Buprenorphine/naloxone, oral, greater than 10 mg

J2310                              Injection, naloxone (Narcan), 1mg

J2315                              Injection, naltrexone (Vivitrol), depot form, 1 mg J8499           HG   Oral naloxone, per 50 mg tablet

 

 

Medical Services

CPT/HCPCS         Modifier  Description

 

Medical Services

CPT/HCPCS Modifier Description

 

99201                                    Office or other outpatient visit for the evaluation and management of a new patient

99201                              Office or other outpatient visit for the evaluation and management of a new patient

99202                                    Office or other outpatient visit for the evaluation and management of a new patient

99202                              Office or other outpatient visit for the evaluation and management of a new patient

99203                                    Office or other outpatient visit for the evaluation and management of a new patient

99203                              Office or other outpatient visit for the evaluation and management of a new patient

99204                                    Office or other outpatient visit for the evaluation and management of a new patient

99204                              Office or other outpatient visit for the evaluation and management of a new patient

99205                                    Office or other outpatient visit for the evaluation and management of a new patient Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care

99211                                    professional.

Office or other outpatient visit for the evaluation and management of an established

99212                                    patient

Office or other outpatient visit for the evaluation and management of an established

99213                                    patient

Office or other outpatient visit for the evaluation and management of an established

99214                                    patient

Office or other outpatient visit for the evaluation and management of an established

99215                                    patient

99341                                    Home visits for the evaluation and management of a new patient

99342                                    Home visits for the evaluation and management of a new patient

99343                                    Home visits for the evaluation and management of a new patient

99344                                    Home visit for the evaluation and management of a new patient

99345                                    Home visit for the evaluation and management of a new patient

99347                                    Home visit for the evaluation and management of an established patient

99348                                    Home visit for the evaluation and management of an established patient

99349                                    Home visit for the evaluation and management of an established patient

99350                                    Home visit for the evaluation and management of an established patient Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour when added on to an evaluation and

+99354                                  management code

Prolonged service in the office or other outpatient setting each additional thirty minutes when added on to +99354 when the +99354 is added on to an evaluation and

+99355                                  management code

Nursing Services performed by an RN with a mental health diagnosed patient related to

H2019                                   their mental health condition

Nursing Services performed by an LPN with a mental health diagnosed patient related

H2017                                   to their mental health condition

 

H0040               AM/SA/UC Assertive Community Treatment, Prescriber billing event

99205                              Office or other outpatient visit for the evaluation and management of a new patient Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care

99211                              professional.

Office or other outpatient visit for the evaluation and management of an established 99212         patient

Office or other outpatient visit for the evaluation and management of an established 99213         patient

Office or other outpatient visit for the evaluation and management of an established 99214         patient

Office or other outpatient visit for the evaluation and management of an established 99215         patient

99341                              Home visit for the evaluation and management of a new patient

99342                              Home visit for the evaluation and management of a new patient

99343                              Home visit for the evaluation and management of a new patient

99344                              Home visit for the evaluation and management of a new patient

99345                              Home visit for the evaluation and management of a new patient

99347                              Home visit for the evaluation and management of an established patient 99348    Home visit for the evaluation and management of an established patient 99349    Home visit for the evaluation and management of an established patient 99350    Home visit for the evaluation and management of an established patient

Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour when added on to an evaluation and

+99354                            management code

Prolonged service in the office or other outpatient setting each additional thirty minutes when added on to +99354 when the +99354 is added on to an evaluation and

+99355                            management code

Nursing Services performed by an RN with a substance use disorder diagnosed patient T1002      related to their SUD condition

Nursing Services performed by an LPN with a substance use disorder diagnosed T1003           patient related to their SUD condition

Alcohol and/or drug services; ambulatory detoxification. Nursing services performed by H0014     an RN/LPN.

93000                              Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report

H0040                                   Assertive Community Treatment, RN/LPN billing event

93000                                    Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report

 

93005                                    Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report

93010                                    Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only

 

96372                                    Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

 

93005                              Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report

93010                              Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only

 

96372                              Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

H0048                             Alcohol and/or other drug testing: collection and handling only, specimens other than blood (not incident to another professional code; not in a residential setting). (Urine

Drug Screening)

H0048                                   Alcohol and/or other drug testing: collection and handling only, specimens other than

blood (not incident to another professional code; not in a residential setting). (Urine Drug Screening)

 


 

 

Vaccine Administration codes and Vaccines

Immunization administration through 18 years of age via any route of administration, 90460         with counseling by physician or other health care professional; first or only component

of each vaccine or toxoid administered

90471                                    Immunization administration (includes percutaneous, intradermal, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid

90472                                    Immunization administration; each additional vaccine. List separately in addition to code for primary procedure (add-on to 90471

90473                                    Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

Immunization administration by intranasal or oral route; each additional vaccine (single

90474                                    or combination vaccine/toxoid) (List separately in addition to code for primary procedure), (add-on to 90473)

90633                                    Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use

90634                                    Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use

90632                                    Hepatitis A vaccine (HepA), adult dosage, for intramuscular use

90371                                    Hepatitis B immune globulin (HBIg), human, for intramuscular use

90650                                    Human Papillomavirus vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use

90649                                    Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use

Meningococcal conjugate vaccine, serogroups C & Y and Haemophilus influenza type b 90644        vaccine (Hib-MenCY), 4 dose schedule, when administered to children 6 weeks-18

months of age, for intramuscular use

90698                                    Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenza type b, and inactivated poliovirus vaccine (DTaP-IPV/Hib), for intramuscular use

90654                                    Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use

90658                                    Influenza virus vaccine, trivalent (IIV3), split virus, when administered to individuals 3 years of age and older, for intramuscular use

90660                                    Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use

90670                                    Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use

90680                                    Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use

90681                                    Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus

90696                                    vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for

intramuscular use

90713                                    Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use

90707                                    Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use 90710    Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use

90714                                    Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use

90715                                    Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use

90716                                    Varicella virus vaccine (VAR), live, for subcutaneous use

90736                                    Shingles vaccine (HZV), live, for subcutaneous injection (individuals 60+ years old) Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed

90732                                    patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use

90733                                    Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use

90734                                    Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MenACWY), for intramuscular use

90740                                    Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use

90746                                    Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use

90747                                    Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose

schedule, for intramuscular use

 

Vaccine Administration codes and Vaccines

Immunization administration through 18 years of age via any route of administration, 90460   with counseling by physician or other health care professional; first or only component

of each vaccine or toxoid administered

90471                              Immunization administration (includes percutaneous, intradermal, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid

90472                              Immunization administration; each additional vaccine. List separately in addition to code for primary procedure (add-on to 90471

90473                              Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

Immunization administration by intranasal or oral route; each additional vaccine (single 90474    or combination vaccine/toxoid) (List separately in addition to code for primary

procedure), (add-on to 90473)

90633                              Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use

90634                              Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use

90632                              Hepatitis A vaccine (HepA), adult dosage, for intramuscular use 90371      Hepatitis B immune globulin (HBIg), human, for intramuscular use

90650                              Human Papillomavirus vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use

90649                              Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use

Meningococcal conjugate vaccine, serogroups C & Y and Haemophilus influenza type b 90644  vaccine (Hib-MenCY), 4 dose schedule, when administered to children 6 weeks-18

months of age, for intramuscular use

90698                              Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenza type b, and inactivated poliovirus vaccine (DTaP-IPV/Hib), for intramuscular use

90654                              Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use

90658                              Influenza virus vaccine, trivalent (IIV3), split virus, when administered to individuals 3 years of age and older, for intramuscular use

90660                              Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use

90670                              Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 90680      Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use

90681                              Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus

90696                              vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for

intramuscular use

90713                              Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use 90707      Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use

90710                             Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use

90714                              Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use

90715                              Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use

90716                              Varicella virus vaccine (VAR), live, for subcutaneous use

90736                              Shingles vaccine (HZV), live, for subcutaneous injection (individuals 60+ years old) Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed

90732                              patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use

90733                              Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use

90734                              Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MenACWY), for intramuscular use

90740                              Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use

90746                              Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use

90747                              Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose

schedule, for intramuscular use

 

 

 

CLIA Exempt Tests/Labs

 

 

CLIA Exempt Tests/Labs

 

86580

36415

Skin test; tuberculosis, intradermal

Collection of venous blood by venipuncture

86580                              Skin test; tuberculosis, intradermal

36415                              Collection of venous blood by venipuncture

82075

Alcohol (ethanol), breath

82075                              Alcohol (ethanol), breath

 


MH and SUD Counseling and Therapy Services/Coding

 

 

Behavioral Health Counseling and Therapy

MH Conditions

CPT/HCPCS  Modifier  Description

90832                                Psychotherapy, 30 minutes with patient and/or family member.

 

Psychotherapy, 30 minutes with patient and/or family member when performed with an E&M service (list separately in addition to the code for primary procedure). (Use

+90833                              90833 in conjunction with 99201–99255, 99304–99337, 99341–99350).

90834                                Psychotherapy, 45 minutes with patient and/or family member.

 

Psychotherapy, 45 minutes with patient and/or family member when performed with an E&M services (list separately in addition to the code for primary procedure). (Use

+90836                              90836 in conjunction with 99201–99255, 99304–99337, 99341–99350).

Psychotherapy, 60 minutes with patient and/or family member.

90837

Prolonged service in the office or other outpatient setting requiring direct patient

+99354                              contact beyond the usual service; first hour when added on to 90837 Prolonged service in the office or other outpatient setting each additional thirty

+99355                              minutes when added on to +99354 when the +99354 is added on to 90837

Psychotherapy, 60 minutes with patient and/or family member when performed with an E&M services (list separately in addition to the code for primary procedure). (Use 90838 in conjunction with 99201–99255, 99304–99337, 99341–99350). (Use 90785 in

conjunction with 90832, 90833, 90834, 90836, 90837, 90838 when psychotherapy

+90838                              includes interactive complexity services.)

90839                                Psychotherapy for crisis; first 60 minutes.

+90840                              Psychotherapy for crisis; each additional 30 minutes.

90846                                Family psychotherapy (without the patient present).

90847                                Family psychotherapy (conjoint psychotherapy) (with patient present).

90849                                Multiple-family group psychotherapy.

90853                                Group psychotherapy (other than of a multiple-family group).

+90785                              Interactive Complexity when added on to a psychotherapy code

H2012                                MH Day Treatment (hourly)

H2020                                MH Day Treatment (per diem)

H2015                                Intensive Home-Based Treatment

 

Behavioral Health Counseling and Therapy

SUD Conditions

CPT/HCPCSModifier Description

90832                           Psychotherapy, 30 minutes with patient and/or family member.

 

Psychotherapy, 30 minutes with patient and/or family member when performed with an E&M service (list separately in addition to the code for primary procedure). (Use

+90833                         90833 in conjunction with 99201–99255, 99304–99337, 99341–99350).

90834                           Psychotherapy, 45 minutes with patient and/or family member.

 

Psychotherapy, 45 minutes with patient and/or family member when performed with an E&M services (list separately in addition to the code for primary procedure). (Use

+90836                         90836 in conjunction with 99201–99255, 99304–99337, 99341–99350).

Psychotherapy, 60 minutes with patient and/or family member.

90837

Prolonged service in the office or other outpatient setting requiring direct patient

+99354                         contact beyond the usual service; first hour when added on to 90837 Prolonged service in the office or other outpatient setting each additional thirty

+99355                         minutes when added on to +99354 when the +99354 is added on to 90837

Psychotherapy, 60 minutes with patient and/or family member when performed with an E&M services (list separately in addition to the code for primary procedure). (Use 90838 in conjunction with 99201–99255, 99304–99337, 99341–99350). (Use 90785 in

conjunction with 90832, 90833, 90834, 90836, 90837, 90838 when psychotherapy

+90838                         includes interactive complexity services.)

90839                           Psychotherapy for crisis; first 60 minutes.

+90840                         Psychotherapy for crisis; each additional 30 minutes.

90846                           Family psychotherapy (without the patient present).

90847                           Family psychotherapy (conjoint psychotherapy) (with patient present). 90849          Multiple-family group psychotherapy.

90853                           Group psychotherapy (other than of a multiple-family group).

+90785                         Interactive Complexity when added on to a psychotherapy code H0004  BH counseling and therapy, per 15 minutes.

H0004         UT             BH counseling and therapy, per 15 minutes. (patient in crisis). H0005                               Alcohol and/or drug services; group counseling by a clinician.

H0015                          Alcohol and/or drug services; intensive outpatient LOC - group counseling only

 

 

H0040

 

Assertive Community Treatment, Licensed/Master's billing event

 

H0040

 

Assertive Community Treatment, Bachelor's billing event

H0015

TG

Alcohol and/or drug services; partial hospitalization LOC - group counseling only

 


MH and SUD Assessment, Evaluation and Testing

 

 

Behavioral Health Assessment, Evaluation and Testing

MH Conditions

CPT/HCPCS  Modifier Description

90791                                Psychiatric diagnostic evaluation.

96136 - 1st                        Psychological or neuropsychological test administration and scoring by physician or 30 Min. /      other qualified health care professional, two or more tests, any method

96137 - Add'l

30 Min.

 

Behavioral Health Assessment, Evaluation and Testing

SUD Conditions

CPT/HCPCS  Modifier Description

90791                               Psychiatric diagnostic evaluation.

96136 - 1st                       Psychological or neuropsychological test administration and scoring by physician or 30 Min. /     other qualified health care professional, two or more tests, any method

96137 - Add'l

30 Min.

 

96130 - 1st                        Psychological testing evaluation services by physician or other qualified health care 60 Min. /       professional, including selection of the appropriate tests to be administered,

96131 - Add'l                     integration of patient data, interpretation of standardized test results and clinical data, 60 Min.       clinical decision making, treatment planning and report, and interactive feedback to

the patient, family member(s) or caregiver(s)

96130 - 1st                       Psychological testing evaluation services by physician or other qualified health care 60 Min. /                     professional, including selection of the appropriate tests to be administered,

96131 - Add'l                    integration of patient data, interpretation of standardized test results and clinical data, 60 Min.      clinical decision making, treatment planning and report, and interactive feedback to

the patient, family member(s) or caregiver(s)

96132 - 1st                        Neuropsychological testing evaluation services by physician or other qualified health 60 Min. /     care professional, including integration of patient data, interpretation of standardized 96133 - Add'l   test results and clinical data, clinical decision making, treatment planning and report, 60 Min.                        and interactive feedback to the patient, family member(s) or caregiver(s)

96132 - 1st                       Neuropsychological testing evaluation services by physician or other qualified health 60 Min. /     care professional, including integration of patient data, interpretation of standardized 96133 - Add'l                       test results and clinical data, clinical decision making, treatment planning and report, 60 Min.  and interactive feedback to the patient, family member(s) or caregiver(s)

96112 - 1st                        Developmental test administration (including assessment of fine and/or gross motor, 60 Min. /     language, cognitive level, social, memory and/or executive functions by standardized 96113 - Add'l   developmental instruments when performed), by physician or other qualified health 60 Min.  care professional, with interpretation and report

96112 - 1st                       Developmental test administration (including assessment of fine and/or gross motor, 60 Min. /    language, cognitive level, social, memory and/or executive functions by standardized 96113 - Add'l   developmental instruments when performed), by physician or other qualified health 60 Min. care professional, with interpretation and report

96116 - 1st                        Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, 60 Min. /        eg, acquired knowledge, attention, language, memory, planning and problem solving, 96121 - Add'l      and visual spatial abilities), per hour of the psychologist's or physician's time, both face-60 Min.              to-face time with the patient and time interpreting test results and preparing the

report

96116 - 1st                       Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, 60 Min. / eg, acquired knowledge, attention, language, memory, planning and problem solving, 96121 - Add'l                     and visual spatial abilities), per hour of the psychologist's or physician's time, both face-60 Min.           to-face time with the patient and time interpreting test results and preparing the

report

90792                                Psychiatric diagnostic evaluation - includes medical.

G0396                                Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., Alcohol Use Disorders Identification Test [AUDIT], Drug Abuse Screening Test [DAST]) and brief intervention (SBI) services, 15 to 30 minutes.

G0397                                Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST) and brief intervention (SBI) services, over 30 minutes.

90792                               Psychiatric diagnostic evaluation - includes medical.

 

 

H0001                               Alcohol and/or drug assessment (not incident to a licensed practitioner's assessment).

 


MH and SUD Coordination and Support Services

 

Behavioral Health Coordination and Support Services

MH Conditions CPT/HCPCS          Modifier Description

Psychosocial Rehabilitation performed by QMHS (not

H2017                           LPN)

Therapeutic Behavioral Services performed by QMHS

H2019                           (not RN)

H0036                           Community Psychiatric Supportive Treatment

H0038                           Peer Recovery Support

Individual Placement and Support - Supported

H2023                           Employment, initial visit

H2025                           Individual Placement and Support - Supported Employment, ongoing visits

Behavioral Health Coordination and Support Services

SUD Conditions CPT/HCPCS Modifier Description

 

H0006                       Alcohol and/or drug services; case management

H0038                       Peer Recovery Support

 


SUD Residential

 

 

SUD Residential Treatment, including withdrawal management

SUD Conditions

CPT/HCPCS       Modifier Description

H0012                                      Alcohol and/or drug services; sub-acute detoxification (residential addiction program outpatient)

H0010                                      Alcohol and/or drug services; sub acute detoxification (residential addiction program inpatient). (3.2-WM)

H0011                                      Alcohol and/or drug services; acute detoxification (residential addiction program inpatient). (3.7-WM)

H2034                                      Alcohol and/or drug abuse halfway house services, per diem. (3.1)

H2036                 HI                 Alcohol and/or other drug treatment program, per diem. Cognitive Impairment. (3.3) H2036               Alcohol and/or other drug treatment program, per diem. (3.5)

H2036                 TG                Alcohol and/or other drug treatment program, per diem. (3.7)

 

 


OhioMHAS Housing & Services Oriented Residence Categories & Definitions Crosswalk

Category

Definition

Types of Housing

Examples

 

Permanent Housing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A housing setting located in the community of the individual’s choice and may be scattered site or a single site housing complex. Services and supports are not mandatory. May have some expectations which is agreed to within the lease if included in the housing.

Supports can be on-site or off-site depending on individual need and specific setting. Length of stay is determined by the lease and individual not a program.

Permanent Supportive Housing

 

Provides access both to affordable housing and to a flexible and comprehensive array of supportive services designed to help tenants to achieve and sustain housing stability and to move toward recovery. Housing is covered by Ohio tenant landlord law. PSH is an evidence-based practice for people with mental illnesses and is typically defined by the following features:

 

Tenant households execute leases (or sub-lease) agreements with the same rights and responsibilities as other households renting housing in the community;

Supportive services are readily available to tenants, are designed to promote housing stability and include access to crisis services 24 hours a day, seven days a week;

Supportive services are flexible and individualized, adjusted to meet the tenants’ evolving needs and preferences;

On-going participation in supportive services is not required for tenants to retain their housing; and

  Access to the housing opportunity and the services is not time-limited.

  Private Apartments, House, Duplex, Condo

 

  Home Ownership

 

  Supportive Housing

 

  Section 8 Voucher

 

  Housing First

Recovery Residence

 

Housing for individuals recovering from alcoholism or drug addiction that provides an alcohol and drug-free environment, peer support, and assistance with obtaining services. Other services may include addiction recovery aids, employment assistance, room and board, and various levels of recovery based services. House rules and administrative rules apply. Treatment services are received off site and billed separately, if applicable. Agency-or owner-operated with various levels of staff. Resident’s often live in a congregate setting. May have a standard tenant landlord lease or general lease agreement with program rules. Recovery Housing levels are defined by the following features:

 

Level 1: Peer-run, democratically run; housing often provided in shared living environments such as single family residences; most often no paid positions to run the housing. Support services include self-help and drug screening, house meetings.

 

Level 2: Monitored by one house manager who screens potential residents; shared living environment such as single family residences; structured. Support services include self-help and drug screenings, no clinical services provided in house. Referral linkages to community based services may be available.

  Level 1 Recovery Residence

 

  Level 2 Recovery Residence

 

  Sober House

 

  Oxford

Service Enriched Housing

 

A housing setting (service-enriched housing) in which a person living in an apartment or shared living setting where he/she entered into an agreement that is NOT covered by Ohio tenant landlord law. Housing is contingent upon adherence to rules or specific services.

Financial sponsorship and/or provision of some degree of on-site supervision. Will be ADAMH/CMH/ADAS Board or provider owner owned and managed.

  OhioMHAS Licensed Type 2 or Type 3

 

  Adult Family Home

 

  Adult Group Home

 

  Next Step Housing

 

  Supervised Group Living

 

Residential Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A congregate or shared living setting that includes room, board, and personal care as part of tenant rent. Depending on residents level of functioning and care needs, may have 24/7 staffing, and assistance with activities of daily living. Services are included and delivered as defined in license. A resident agreement that includes participation in services may be applicable. Residential Care is owned and operated by a private owner or provider agency.

 

May or may not be a long term more permanent housing depending on level of care needed for the individual. This type of housing is licensed and is not subject to tenant landlord law but does require a resident agreement.

Group Home

 

A congregate living environment to provide supervised care to individuals 18 years or older. Licensed by the state, includes room and board and may or may not include personal care or mental health services. Reasons for this placement level of care are more environmental in nature than psychiatric. May provide supervision, social services and accommodations, but treatment services are provided separately and service intensity will vary from client to client. May or may not be a long term more permanent housing depending on level of care needed for consumer.

  Private Apartments, House, Duplex, Condo

 

  Home Ownership

 

  Supportive Housing

 

  Section 8 Voucher

 

  Housing First

Residential Care Facilities (Health)

 

Licensed through the Ohio Department of Health may or may not share a bedroom. Residential care facility” is a home that provides either of the following: (a) Accommodations for 17 or more unrelated individuals and supervision and personal care services for three or more of those individuals who are dependent on the services of others by reason of age or physical or mental impairment; mha.ohio.gov 2 OhioMHAS Housing Categories and Definitions July 2014 (b) Accommodations for three or more unrelated individuals, supervision and personal care services for at least three of those individuals who are dependent on the services of others by reason of age or physical or mental impairment, and, to at least one of those individuals, supervision of special diets or application of dressings or provide for the administration of medication to residents to the extent authorized. Can be called Assisted Living.

  Residential Care

 

  Assisted Living

 

  County Home

 

  Group Home

Licensed ODODD Facility

 

Refers to any Ohio Department of Developmental Disabilities-licensed group home or community facility (that is not an ICF-IID) where supervision, services and/or accommodations are provided. Examples: Group home for persons with developmental disabilities; Residential facility for persons with developmental disabilities.

 

Child Residential Care/Group Homes

 

A congregate living environment licensed by a county or state department to provide care to children or adolescents. Reasons for this placement level of care are more environmental in nature than psychiatric. Child Residential Care/Group Home may provide supervision, social services and accommodations, but treatment services are provided separately and service intensity will vary from client to client.

 


OhioMHAS Housing & Services Oriented Residence Categories & Definitions Crosswalk

Category

Definition

Types of Housing

Examples

 

Time-Limited/Temporary

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A short term setting that can include room, board, and/or personal care and supports. A setting that provides support needed for an identified length of stay per the program or agreement. Intention is for residents to return to previous housing setting; to move into a more permanent housing setting or a break from current housing. Most often Treatment and/or services are part of facility rules. NOT intended as a permanent housing environment. This setting is not subject to tenant landlord law and would not meet Home and Community Based Settings

Temporary

 

Acute non-hospital, time-limited residential program with an expected length of occupancy and goals to transition to permanent housing. Includes room and board with referral and access to treatment services that are billed separately.

 

Transitional

 

Time-limited, usually connected to a program with a completion timeframe. Services and supports required as part of program. Stay is not Resident driven.

 

Recovery Residence - Level 3 (IOP required)

 

Supervised, organizational hierarchy with administrative oversight; found in all types of residential settings staffed by a facility manager. Certified staff or case managers, support services include life skills development, emphasis on clinical services. Services provided through the program are limited.

  Level 3 Recovery Residence

Recovery Residence - Level 3 (IOP NOT required)

 

Supervised, organizational hierarchy with administrative oversight; found in all types of residential settings staffed by a facility manager. Certified peer support, support services include life skills development emphasis on non-clinical supports that may include employments services, daily living skills, social supports. Robust non-clinical programming designed to enhance retention in clinical services (if applicable) and provide recovery supports.

  Level 3 Recovery Residence

Crisis Care

 

Provision of short-term care to stabilize person experiencing a psychiatric emergency. Offered as an alternative to inpatient psychiatric unit. Staff 24 hours a day/seven days a week. Treatment services are billed separately.

 

Respite Care

 

Short-term environment, it may or may not be 24-hour care. Reasons for this type of care are more environmental in nature. May provide supervision, services and accommodations. Treatment services are billed separately.

 

Foster

 

Living situations in which the client resides with a non-related family or person in that person’s home for purpose of receiving care, supervision, assistance and accommodations. Treatment services are billed separately. Licensed through the state.

 

 

Residential Treatment

 

 

 

 

 

 

 

 

 

 

 

 

 

A facility/program that is staffed 24 hours a day/seven days a week and provides room, board, personal care and clinical services on-site as part of the treatment stay. Admission to the facility/program is determined by clinical and medical need.

OhioMHAS Type 1 Residential Facilities

 

Provides room, board, personal care and certified mental health services to one or more adults, children or adolescents. The facility is licensed and certified by OhioMHAS. Reasons for this level of care are psychiatric or behavioral in nature environmental. Not a long-term placement as clinical services are on-site. For the purposes of this crosswalk, only the associated room and board for residents is considered.

  OhioMHAS Type 1 Residential Facilities

OhioMHAS Certified SUD Residential Treatment Program

 

SUD residential treatment programs provide a structured environment for the delivery of SUD treatment. These programs operate 24 hours a day 7 days per week and 365 days per year and are staffed accordingly. SUD treatment is provided under program defined and developed policies and procedures and clinical protocols. For the purposes of this crosswalk, only the associated room and board for residents is considered.

  SUD Residential Treatment Programs

 

Housing Development

 

 

 

 

 

 

 

 

 

 

 

Housing and Residential activities performed by a Board or a Provider that enhances client services and supports within the community.